Lymphatic drainage patterns in head and neck lymphoedema: A preliminary imaging study with indocyanine green lymphography
Head and neck lymphoedema occurs as a consequence of the failure of damaged lymphatics to sufficiently drain lymph from the soft tissues of the head and neck (Földi et al, 2006). Damage to the lymphatic nodes and vessels in the head and neck from cancer treatment may result in lymph stasis and dermal backflow or […]
Compression in 2023 and beyond –what we really need!
“If a tree falls in a forest and no one is around to hear it, does it make a sound?” While this old philosophical question has been answered many times in thought experiments regarding observation and perception, it is never from the perspective of the tree. Crafting a brief but poignant analogy to segue the […]
Abstract highlights BLS 2022 and a taster of 2023
A case report of lower leg amputation: The unfortunate sequelae of lymphoedema compression garment complication Katie R HilderPlastic Surgery Registrar, Ninewells Hospital, Dundee Scotland The COVID-19 pandemic caused significant issues relating to social distancing and mandatory isolation of patients. The literature is increasingly demonstrating the harmful psychiatric effects that COVID-19 induced social isolation has had […]
Complication profile of combined microvascular breast reconstruction combined with vascularised lymph node transplant
Lymphoedema is a common sequela of breast cancer and its treatment, affecting 16–21% of patients (McLaughlin et al, 2008; DiSipio et al, 2013) and leading to additional medical costs and diminished quality of life secondary to upper extremity pain, cellulitis, and chronic wounds (Brayton et al, 2014; Basta et al, 2016; De Brucker et al, […]
Association of self-management skills with patient characteristics and lymphoedema development in women with breast cancer: a cross-sectional observational study
Secondary lymphoedema may occur as a sequela of lymph node dissection and have an adverse impact on quality of life (Tiwari et al, 2013; Rafn, 2022). The main risk factors for lymphoedema are radiotherapy, obesity, infection, and taxane-based chemotherapy (McLaughlin et al, 2020; Cariati et al, 2015; Shah et al, 2016). In Japan at least, […]
Typologies of adaptation: parenting children with primary lymphoedema
Primary lymphoedema results from congenital lymphatic damage that requires lifelong management of symptoms (e.g. swelling, pain, heaviness). Approximately 1.2 in 100,000 people under the age of 20 years live with lymphoedema (Smeltzer et al, 1985; Rockson and Rivera, 2008). Researchers have studied the impact of children’s lymphoedema on parents regarding parental support (Todd, 2019; Todd […]
Breast, chest and truncal lymphoedema occurrence following risk-reducing mastectomy: a review of the literature
The presence of a BRCA gene mutation has been predicted to increase lifetime risk of breast cancer by 72% for BRCA 1 carriers and 69% for BRCA 2 carriers (Kuchenbaecker et al, 2017), a significant increase when compared to the projected 12% lifetime risk of a woman without this mutation (McCarthy et al, 2017). While […]
Free flap steal syndrome and the loss of free lymphatic tissue flap transplantation in lymphoedema surgery: A case report
Skin flap necrosis can be devastating for the microsurgeon after long hours of effort and meticulous surgical techniques. Although many extrinsic and intrinsic factors have been discussed in the literature, it is still difficult to ascertain the precise cause of a flap failure other than insufficient arterial blood supply (Kerrigan, 1983). Free superficial circumflex iliac […]
Is manual lymphatic drainage with bio-electric massage therapy a good treatment combination for lymphoedema and lipoedema? A case study
Lipoedema, or adiposis dolorosa, is a common adipose tissue disorder that is believed to affect nearly 11% of adult women worldwide (Buck and Herbst, 2016). It is characterised most by disproportionate adipocyte hypertrophy of the lower extremities, significant tenderness to palpation, and a failure to respond to extreme weight loss modalities (Buck and Herbst, 2016). […]
Subcutaneous cannula drainage for symptomatic lower limb oedema in advanced cancer: a case study
Lower limb lymphoedema is increasingly being recognised as a troubling symptom for people with advanced cancer. The literature suggests the incidence of lower limb lymphoedema in advanced cancer is currently between 25–80% (Landers and Thomson, 2017). Lymphoedema occurs when there is compromise to the lymphatic system through a variety of mechanisms. Primary lymphoedema is the […]
Use of wound antiseptics in practice
Prevention, detection, treatment and management of wound infection remains a paramount concern for clinicians worldwide. Wound infection is a complex manifestation in which microorganisms outcompete the host immune system (Haalboom et al, 2019), and it is considered to be one of the most common and serious challenges hindering the wound healing process (Mota et al, […]
Fundamentally absent
It is common to hear wound care providers complain about the accuracy of staging pressure ulcers and inappropriate wound care practices. I also have complained about these many times. I wondered if some of the issues may be in the education of providers. So, I looked at several fundamentals of nursing textbooks to see what […]
Ten top tips: common wound errors and means to correct
“To err is human.” As Alexander Pope stated, humans make mistakes (Pope, 1711). In healthcare, mistakes can be as simple as a typo or as complicated as an incorrect diagnosis and treatment plan. Wound care is not exempt from errors, and errors can have a significant impact on patient progress and healing. Both authors serve […]
Wound Care Respondents’ Voices During COVID-19: Canadian Qualitative Serial Survey —final results
This study aimed to contribute to a growing body of literature focused on how the coronavirus pandemic in Canada was a shaping influence on the lives of respondents and the delivery of wound care services in the country over time. Ethics and informed consent The study adhered to ethics and consent protocols and was subject […]
Zero All Preventable (ZAP) amputations: FDUK position statement on “missingness” and reducing major amputations in the acute diabetes foot pathway
Foot in Diabetes UK (FDUK) is a UK collaborative of healthcare professionals (HCPs) working across national boundaries to deliver high-quality clinically effective care in order to improve the lives of people living with foot problems associated with diabetes. There is an urgent and unmet need across the UK to reduce the number of avoidable lower-limb […]
Demonstrating the clinical efficacy of a multi-modality approach to managing various wound aetiologies
There is a significant concern in the Caribbean about severe lower-extremity amputations. More specifically, in 2021, Pran and colleagues reported that the average annual major lower-limb amputation rate in Trinidad & Tobago is about 600 (596.5), with an average daily rate of 1.63 (Pran et al, 2021). This statistic is staggering, considering the Trinidad & […]
Health economics in wound management
Session one – Health economics in wound management: Pinaki Ghosh, B. Braun Medical Industries, Pulau Pinang, Malaysia Pinaki Ghosh began the session by discussing health economics in wound management. An overview of the general ideal of health economic data was shared, including the importance of taking a value-based healthcare (VBH) approach to achieve better outcomes […]
Building the business case for shared wound care: a cost-benefit case for service providers
Nurse practitioners play a vital role in advocating for practice change and should be involved in health policy formulation and decision making to drive the effectiveness of healthcare systems. Motivated by patient experience, informal carer experience and optimal use of their time, numerous nurses are already adopting a shared care approach when managing patients with […]
Paving the way for effective wound care education for the non-specialist — developing five evidence-based wound type specific pathways
While chronic wounds have devastating consequences for patients and contribute significant costs to health care systems and society, health care professionals (HCPs) find assessing, treating and healing chronic wounds a challenge (Posnett and Franks, 2008; Patel et al, 2008; Frykberg and Banks, 2015; Guest et al, 2015, 2020; Olsson et al, 2019; Martinengo et al, […]
A ‘Quick Guide’ to pressure injury management
1. ForewordPressure injuries, also referred to as pressure ulcers, pressure sores, bedsores or decubitus ulcers (Wound, Ostomy and Continence Nurses Society; WOCN, 2017), are a common and preventable health problem. They impose significant health and economic burdens on patients, caregivers and healthcare systems. For the patient, pressure injuries can have a major impact on quality […]
Pressure ulcers and skin tone
Definition and prevalence rate of pressure ulcers As defined by the European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Ulcer Advisory Panel (NPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA), a pressure ulcer is ‘localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in […]
SSI Surveillance: Promoting a seamless patient journey from surgery to community
Surgical site infections (SSIs) are consistently identified as the most frequent type of healthcare-associated infection (HAI) in low- and middle-income countries (LMICs; WHO, 2016) and they are associated with considerable morbidity, mortality, and financial burden (Cassini et al, 2016). SSIs have a negative impact on physical and mental health, and may lead to a loss […]
Wound care and skin tone: Signs, symptoms and terminology for all skin tones
While patient populations vary across the world, evidence shows that in many areas there are discrepancies in wound care due to variations in skin tone; for example, patients with dark skin are more likely to be diagnosed with higher-category pressure ulcers (PUs) (Oozageer Gunowa et al, 2017). This is due to a lack of accurate […]
Slough: Composition, analysis and effect on healing
Slough can be defined as “non-viable tissue of varying colour (e.g. cream, yellow, greyish or tan) that may be loose or firmly attached, slimy, stringy or fibrinous” (Haesler et al, 2022; International Wound Infection Institute [IWII], 2022). Slough consistency is determined by the tissue’s hydration status and interaction with the dressing material, as well as […]
Made Easy: Hydrocyn Aqua®
Wound hygiene is a protocol of care that encourages a proactive and systematic approach to facilitate healing of chronic wounds, through consistent and repetitive cleansing and decontamination (Murphy et al, 2020). Referred to as the management of a wound to optimise healing, wound bed preparation (WBP) is a framework for assessment, diagnosis and treatment of […]
Made Easy: Wound Care and Skin Tone
Evidence shows that in many areas around the world, there are discrepancies in wound care due to variations in skin tone. The need for information in this area resulted in the international consensus document Wound Care and Skin Tone (Dhoonmoon et al, 2023). This Made Easy provides an overview of the full document, which is […]
Made Easy: Shared wound care discussion guide
‘Shared wound care’ encompasses approaches and interventions that enable patients to participate in care planning and delivery. These shared care practices, including the monitoring and changing of dressings, can transform a patient’s role from that of a passive recipient of care to an active participant (Wounds International, 2016). Many nurses who treat patients with chronic […]
The wide world of wounds
There was a sports programme on television in the US for almost 40 years, called the Wide World of Sports. The programme was popular and showed a great variety of sports and athletes from around the world competing in sports that we seldom saw in the US, like cliff diving, hurling and even badminton. Why […]
Ten top tips: pressure ulcers on the heels
1. Heel ulcers are more common than you may realise Some of the largest samples of pressure ulcer data are from many years of work by VanGilder (2021), including a voluntary point prevalence study (International Pressure Ulcer Prevalence [IPUP] Survey) completed in US acute care hospitals, which yielding rich data for study. An in-depth analysis […]
Use of artificial intelligence in wound care education
Artificial intelligence (AI) is quickly becoming integrated throughout various domains, including healthcare. In particular, wound care has been experiencing rapid growth in the integration of AI-based technologies. A recent systematic review on image-based artificial intelligence found over 250 articles on wound assessment, measurement, and diagnosis (Anisuzzaman et al, 2022). While computer vision technologies are becoming […]
Local resource wound treatments: evidence summaries for resource-limited settings
Although accurate data on the global prevalence of wounds are limited (Martinengo et al, 2019), epidemiological data suggest that chronic wounds are increasing over time as life expectancy increases (Gupta et al, 2021). The burden of wounds is disproportionate in resource limited communities, and patterns of wounding are different to that seen in high resource […]
How does skin tones affect staff confidence when dealing with pressure ulcers
Early identification of changes to the skin is one of the most important tools to protect patients who are at risk of developing pressure ulcers (Haesler, 2019). Recognition and appropriate management of early signs of pressure damage can prevent the development of more advanced categories of pressure ulcers with significant benefits for patients, as well […]
Single-use NPWT in the management of open, ‘hard-to-heal’ wounds: A case series
It is widely recognised that wounds are a common problem that affect individuals, the healthcare system and society as a whole (Moore et al, 2022). Living with chronic, complex or hard-to-heal wounds often results in a decrease in quality of life with the potential for increased pain and anxiety (Olsson et al, 2019). Opportunities to […]
Use of nano-oligosaccharide factor (sucrose octasulfate) dressing based on Technology Lipido-Colloid (TLC-NOSF) as an interface layer with negative pressure wound therapy
Complex and complicated wounds (CCWs) are a common challenge for clinicians. Despite increased knowledge, wound care innovations and best practices implemented, wound healing is often prolonged. Non-healing wounds easily get infected, causing complications like amputations and even sepsis (Calis et al, 2020). This affects patients psychologically, and increases financial burdens for healthcare systems and patients […]
Blue light photobiomodulation: a therapy to reactivate the healing process of stagnant wounds of different aetiologies
In the literature, we often encounter the term “hard-to-heal” to define a wound that does not tend to heal within the expected timeframe, despite treatment with standard of care. We prefer to define this condition as stagnant; in our opinion, both of these definitions provide us with the exact situation of lesions that, despite adequate […]
Shared wound care and the implementation tipping point: patient engagement to standardise practice
Nurses globally are facing pressures that severely impact their ability to carry out their vital role (Barrett and Heale, 2021; Castro-Ayala et al, 2022; World Health Organization [WHO], 2022). With the prevalence of chronic wounds rising by 71% since 2012, we are currently facing a crisis and new ways of working are required to meet […]
Wounds digest 14-2
In this article, we present brief synopses of a range of recently published articles that may be of interest to healthcare professionals working in the wound care setting. The aim of this round-up isto provide an overview, rather than a detailed summary and critique, of the research papers selected. Full references are provided should you […]
Canada; The OneNPWT clinical decision tree for open wounds
Chronic non-healing wounds present a substantial human and economic burden on healthcare systems across Canada (Hopkins et al, 2015). Evidence-based recommendations are required to guide clinical decisions regarding negative pressure wound therapy (NPWT) systems and to drive clinical, operational, and financial efficiencies for healthcare providers. The OneNPWT clinical decision tree is a clinical decision-making tool […]
White Paper – Wound balance: Achieving wound healing with confidence
The concept of ‘wound balance’ is multifactorial, encompassing interconnecting issues related to the wound healing process and clinical practice. The wound balance concept aims to integrate various critical parameters which offer continuity, individualised care and support clinical decision-making, to place the patient at the centre of all care [Figure 1, see page 4]. Fundamentally, aiming […]
Europe, the Middle East and Africa; The OneNPWT clinical decision tree for open wounds
Chronic non-healing wounds present a substantial economic and epidemiological burden on healthcare systems across Europe, the Middle East and Africa (Gupta et al, 2021). Evidence-based recommendations are required to guide clinical decisions regarding negative pressure wound therapy (NPWT) systems and to drive clinical, operational, and financial efficiencies for healthcare providers. The OneNPWT clinical decision tree […]
Misdiagnosis or missed diagnosis?
The diagnosis of wounds is not easy, yet it is imperative that the aetiology of the wound be understood because the treatment stems from the cause. Diabetic foot ulcers are not treated the same way venous leg ulcers or heel pressure ulcers are managed. Take, for example, a wound on the heel of a person […]
Ten top tips: realistic expectations about amputation
1. Identify, assess and mitigate risk factors early The pathway to a diabetic foot ulcer and subsequent amputation is well-mapped, starting with neuropathy, ischaemia, infection and a preventable sentinel event in 86% of cases (Pecoraro et al, 1990). Prevention of amputation is most successful with early recognition of associated risk factors when a patient presents […]
Physiotherapists’ knowledge and use of electrotherapy in the management of chronic wounds
The skin is the largest sensory organ in the body and is critical for survival due to its role in protecting the individual from the external environment and keeps harmful influences at bay. When the skin is destroyed, damaged, or broken, a regulated sequence of biochemical activities begins to repair the damage through wound healing […]
Phage therapy for diabetic foot infection
Over 4.9 million people in the UK have diabetes mellitus, herein diabetes, and this could rise to 5.5 million by 2030 (Diabetes UK, 2020a). Around one third of patients with diabetes will develop a diabetic foot ulcer at some point (Armstrong et al, 2017). The aetiology of diabetic foot ulcers (DFUs) generally reflects trauma superimposed […]
Management of wounds in Indian patients with poly-absorbent fibres impregnated with a silver lipido-colloid matrix dressing — a case series
Chronic wounds have been defined as wounds that fail to progress in an orderly and timely manner to restore the anatomic and functional integrity of the injured site (Shivani et al, 2021). Those chronic wounds have a clear underlying cause and are largely assigned to leg ulcers (frequently a consequence of venous or arterial deficiencies […]
The impact of venous leg ulcers on a patient’s quality of life: considerations for dressing selection
The term ‘leg ulcer’ is generally used to describe a full-thickness open wound below the knee with a slow healing tendency (Star, 2018). The two most common causes of leg ulceration (excluding the foot) are venous disease (venous leg ulcer, VLU) and arterial disease (arterial leg ulcer, ALU); other causes include diabetes, rheumatoid arthritis, vasculitis, […]
Conference report: 1st Bahrain International Wound Conference
The Bahrain Defence Force Royal Medical Services (BDFRMS) has continuously strived towards working diligently to address the healthcare challenges at the local and international levels. This has resulted in the 1st Bahrain International Wound Conference, making education and best practice in wound care a priority, the first event of its kind in the Kingdom of […]
Necrotising fasciitis and septic shock: A case report of a patient receiving an immunomodulatory agent for multiple sclerosis
Necrotising fasciitis (NF) is a soft tissue infection commonly caused by group A streptococcus (GAS) and is characterised by rapid progression and high mortality. It is considered one of the most dangerous infections in a surgical setting, as it remains silent for a long period and is diagnosed when it has already caused extensive local […]
Wounds digest 14-1
In this section, we present brief synopses of a range of recently published articles that may be of interest to healthcare professionals working in the wound care setting. The aim of this round-up isto provide an overview, rather than a detailed summary and critique, of the research papers selected. Full references are provided should you […]
